1. Outbreak Reporting Sponsored by Navy and Marine Corps Public Health Center U.S. Army Public Health Command Air Force School of Aerospace Medicine Presented on 27 March 2012 by Asha Riegodedios, Staff Epidemiologist, NMCPHC

2. Objectives Outbreak Reporting Requirements When to report an outbreak How to report an outbreak Primary POCs

3. Reporting Requirements Triservice Guidelines – Soon to be Updated: Armed Forces Reportable Medical Events Guidelines & Case Definitions Navy Regulations – NavMed p-117: Manual of the Medical Department – BUMED INST 6220.12C: Medical Surveillance and Medical Event Reporting – NMCPHC-TM-6220.12: Medical Surveillance and Medical Event Reporting Technical Manual Army Regulations – DA PAM 40-11: Preventive Medicine – AR 40-5: Preventive Medicine – MEDCOM OPORD 10-78 (September 2010) Air Force Regulations – AFI 48-105: Surveillance, Prevention, and Control of Diseases and Conditions of Public Health or Military Significance

4. When To Report What is a reportable outbreak? – How many cases? – What about typical increases in disease (i.e. seasonal)? – No single clear definition – requires judgment Any unusual increase in disease incidence should be investigated Any surge in illness above baseline can be reportable, even surges that you believe are “expected” – i.e. GI illness among recruits following a particular training evolution in the late summer/early fall months

5. When To Report Report an outbreak when an increase in illness leads you to: – Identify more cases – Seek causes of the illness and/or – Institute control measures Laboratory confirmation is not required for reporting Outbreaks are reportable regardless of whether the etiologic agent is on the reportable disease list – i.e. adenovirus outbreak When in doubt, report

6. Report clusters involving: Severe illnesses Rapid rise in cases Cases limited to a specific group (demographic, occupational) Highly infectious organism requiring rapid implementation of control measures Potential to affect mission readiness Control measures that are invasive, involve mass prophylaxis, or are resource intensive Potential to attract media attention Vaccine preventable illnesses in highly vaccinated population

7. How To Report On-line via DRSi (Navy/Army) and AFRESS (Air Force) DRSi: Outbreak Report Module AFRESS: “Report New Case” → Select “EPI Event” (Outbreak – 136.9)

8. How to Report in DRSi Once you log in as a MER Recorder, click on “Enter/Edit Outbreak Report(s)”

9. This brings you to the Outbreak Report Main Page You can view and edit previous outbreak reports filed by your reporting unit – Input your date filters and click on “Get Outbreak Report(s)” Click on “Enter New Outbreak Report” to enter a new report

10. Top of the screen

11. Bottom of the screen

12. How to Report in AFRESS Click on “Report New Case” “Report New Outbreak” and “Search Outbreak(s)” are currently inoperable *Future revision of AFRESS will contain an outbreak module, similar to DRSi

13. AFRESS Select “OUTBREAK – 136.9” EPI Event description *Report the outbreak using the index case (first known case)

14. AFRESS Document important features of the outbreak within 500 characters Enter date of onset of index case (first known case) Select an answer from drop down menu Click “Update” when done

15. How to Report Not all outbreaks require a separate MER for each individual case – Check with your Surveillance Hub for guidance File an outbreak report as soon you can, then update it regularly Phone your Primary Surveillance Hub contacts for any further guidance or assistance NOTE: Never contact the CDC without notifying your respective public health command

16. Primary POCs for Outbreak Support and Consultation Navy: Navy Environmental and Preventive Medicine Units (NEPMU) – NEPMU2 COMM: (757) 950-6600; DSN: (312) 377-6600 Email: NEPMU2NorfolkThreatAssessment@med.navy.milNEPMU2NorfolkThreatAssessment@med.navy.mil – NEPMU5 COMM: (619) 556-7070; DSN (312) 526-7070 Email: ThreatAssessment@med.navy.milThreatAssessment@med.navy.mil – NEPMU6: COMM: (808) 471-0237; DSN: (315) 471-0237 Email: NEPMU6ThreatAssessment@med.navy.milNEPMU6ThreatAssessment@med.navy.mil

17. Primary POCs for Outbreak Support and Consultation Air Force: USAF School of Aerospace Medicine Epidemiology Consult Service (USAFSAM/PHR) – Commercial: 937-938-3207 – DSN: 798-3207 – Email: episervices@wpafb.af.milepiservices@wpafb.af.mil Army: U.S. Army Public Health Command – Disease Epidemiology Program – COMM: 410-436-7605 or 410-417-2377 – Email: Disease.epidemiology@amedd.army.milDisease.epidemiology@amedd.army.mil

18. Questions Next Monthly Training: April 24, 2012 Topic: TBD